Research use. Not a legal or regulatory form: if a sponsor or regulator prescribes a form, use that one.
tinysamples.com/templates/
chain-of-custody-form
| No. | Sample ID | Type | Amount | From (freezer, rack, box, position) | Condition on receipt | Temp °C |
|---|---|---|---|---|---|---|
| 1 | ||||||
| 2 | ||||||
| 3 | ||||||
| 4 | ||||||
| 5 | ||||||
| 6 | ||||||
| 7 | ||||||
| 8 | ||||||
| 9 | ||||||
| 10 | ||||||
| 11 | ||||||
| 12 |
Condition: intact, thawed, leaking, label unreadable, or other (say what). Write “not measured” rather than leaving the temperature blank.
Package intact Yes No
Seal number matches Yes No No seal
Dry ice Wet ice Ambient Other
The original travels with the shipment. The sender keeps a copy of what they released. A line that is wrong is not crossed out: add a line that says what was wrong.